Abstract
In a brief consideration of some of the difficulties of delivering electroconvulsive therapy (ECT) services during the pandemic, Warren et al. (2020) urged ‘It is important for psychiatrists to advocate for ongoing access to ECT . . .’ This is because ‘ECT remains one of most effective and fast-acting treatments for acute severe psychiatric conditions, and appropriate use leads to reduced hospital admissions and earlier discharges’.
I find myself unable to share their fervour. Using readily available figures, my study of ECT refutes each and every one of the claims made on its behalf by the RANZCP (McLaren, 2018). In particular, when we look at the enormous discrepancies in ECT usage between countries, between regions and even within cities, it is perfectly clear that ECT use is driven by something other than ‘clinical indications’. For example, in the United Kingdom between 1985 and 2015, ECT declined by about 90%, whereas in Australia between 2005 and 2015, it increased by 87%, including an implausible 191% in Western Australia. In Victoria, ECT is used at approximately 600% of the rate found in New Zealand. Does this mean Victorians suffer ‘acute severe psychiatric conditions’ six times more often than the demographically identical population across the Tasman? I don’t believe they do.
The current Medicare rebate for ECT, Item 14224, is AUD$72.55, which is generous for a few minutes’ work, but private rates are as much as three times higher. My conclusion is that the primary impetus for Australia’s excessive use of this modality is pecuniary. I submit that your correspondents have confused what is good for patients with what is good for psychiatrists. I challenge them to show the error in my assessment as set out in my 2018 paper.
